Euthyroid goitre and sleep apnea

A number of predisposing factors (obesity, nasal obstruction, adenoidal hypertrophy, macroglossia, etc) have been related to obstructive sleep apnea syndrome (OSAS). In addition hypothyroidism and large goitres have been reported to be associated to OSAS, but this association has not been adequately studied. We describe an obese patient with euthyroid goitre associated with OSAS. The patient showed a body mass index (BMI) of 47 and a large neck with a circumference of 60 cm. The flow-volume curve demonstrated an expiratory plateau suggesting an intrathoracic upper airway obstruction. Arterial blood gas analysis results were: pH 7.39; PCO2 54.2 mmHg; P O2 47 mmHg. Nocturnal polisomnography showed an apnea/hypopnea index (AHI) of 31 episodes/hour. Upper airway collapse was overcome by a nasal continuous positive airway pressure (nCPAP) of 14 cmH2O. Weight loss obtained by a hypocaloric diet was not accompanied by any OSAS improvement. After thyroidectomy, a nCPAP of 4 cmH2O was sufficient to prevent upper airway closure. Discontinuation of nCPAP treatment for 4 consecutive nights did not determine worsening of sleep apnea symptoms, nor a worsening of overnight oxymetry. A new polysomnography carried out after 4 nights off nCPAP showed an AHI of 33 episodes/hour. OSAS should be suspected in patients with large goitres. Decisions regarding discontinuation of nCPAP treatment after thyroidectomy should be based on polisomnographic results.

Colchicum autumnalein Patients with Goitre with Euthyroidism or Mild Hyperthyroidism: Indications for a Therapeutic Regulative Effect—Results of an Observational Study

Introduction. Goitre with euthyroid function or with subclinical or mild hyperthyroidism due to thyroid autonomy is common. In anthroposophic medicine various thyroid disorders are treated withColchicum autumnale(CAU). We examined the effects of CAU in patients with goitre of both functional states.Patients and methods. In an observational study, 24 patients with goitre having suppressed thyroid stimulating hormone (TSH) levels with normal or slightly elevated free thyroxine (fT4) and free triiodothyronine (fT3) (group 1,n=12) or normal TSH, fT3, and fT4 (group 2,n=12) were included. After 3 months and after 6 to 12 months of CAU treatment, we investigated clinical pathology using the Hyperthyroid Symptom Scale (HSS), hormone status (TSH, fT4, and fT3), and thyroidal volume (tV).Results. After treatment with CAU, in group 1 the median HSS decreased from 4.5 (2.3–11.8) to 2 (1.3–3) (p<0.01) and fT3 decreased from 3.85 (3.5–4.78) to 3.45 (3.3–3.78) pg/mL (p<0.05). In group 2 tV (13.9% (18.5%–6.1%)) and TSH (p<0.01) were reduced. Linear regression for TSH and fT3 in both groups indicated a regulative therapeutic effect of CAU.Conclusions. CAU positively changed the clinical pathology of subclinical hyperthyroidism and thyroidal volume in patients with euthyroid goitre by normalization of the regulation of thyroidal hormones.

GAMBARAN EUTIROID PADA PASIEN STRUMA MULTINODUSA NON-TOKSIK DI BAGIAN BEDAH RSUP PROF. DR. R. D. KANDOU MANADO PERIODE JULI 2012 – JULI 2014

Goitre is a thyroid gland enlargement due to the increase of thyroid tissue. Goitre can be classified from several aspects: physiological (euthyroidsm, hypothyroidsm, and hyperthyroidism), morphological (diffuse and nodular goitre), and clinical (toxic and non toxic goitre) aspects. Patients with euthyroid goitre have no symptoms because there is no abnormality with the thyroid function. This study aimed to obtain the profile of the non toxic multinodosa goitre patients with euthyroidism in Surgery Department Prof. Dr. R. D. Kandou Hospital Manado period from July 2012 to July 2014. This was a descriptive retrospective study using the medical record of the Surgery Department Prof. Dr. R. D. Kandou Hospital Manado. Of 25 non toxic goitre multinodosa patients, there were 21 (84%) female patient and 4 (16%) male patient. Patients with euthyroidism were 21 cases (84%) and with hypothyroidism 4 cases (16%). Therapy of euthyroid goitre was surgery. The types of surgery for this 25 patient were as follows: 14 (56%) total thyroidectomy, 9 (36%) isthmolobectomy, 1 (4%) nearly total thyroidectomy, and 1 case (4%) subtotal thyroidectomy. Patients with enlargements in the neck should be checked for their thyroid glands and hormones even if they do not have any symptoms, especially if they come from iodine deficiency endemic area.Keywords: goitre, euthyroidAbstrak: Struma adalah pembesaran kelenjar tiroid karena terjadi penambahan jaringan kelenjar tiroid. Struma dapat diklasifikasikan berdasarkan fisiologis (eutirodisme, hipotiroidisme, dan hipertiroidisme), morfologi (struma difus dan nodular) serta berdasarkan klinis (struma toksik dan non toksik). Penderita struma yang eutiroid tidak mempunyai keluhan karena tidak terdapat gangguan fungsi tiroid. Penelitian ini bertujuan untuk mengetahui gambaran pasien struma multinodusa non-toksik yag eutiroid di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Juli 2012 – Juli 2014. Penelitian ini bersifat deskriptif retrospektif dengan memanfaatkan catatan medik di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado. Dari 25 pasien struma multinodusa non-toksik ditemukan bahwa jenis kelamin perempuan sebanyak 21 pasien (84%) dan jenis kelamin laki-laki 4 pasien (16%). Jumlah pasien yang eutiroid sebanyak 21 kasus (84%) dan hipotiroid 4 kasus (16%). Terapi struma eutiroid ialah pembedahan. Dari 25 kasus struma multinodusa non-toksik didapatkan 14 kasus (56%) tiroidektomi total, 9 kasus (36%) istmolobektomi, 1 kasus (4%) tiroidektomi hampir total, dan 1 kasus (4%) tiroidektomi subtotal. Pasien dengan pembesaran di daerah leher sebaiknya langsung dilakukan pemeriksaan kelenjar dan hormon tiroid walaupun tanpa gejala apapun, terutama yang berasal dari daerah endemis kekurangan yodium.Kata kunci: struma, eutiroid

Worldwide prevalence and risk factors for feline hyperthyroidism: A review

Since first reported in the late 1970s, there has been a steady but dramatic increase in the worldwide prevalence of hyperthyroidism in cats. It is now regarded as the most common feline endocrine disorder, with diabetes mellitus coming a close second. Not only is there evidence for an increased worldwide prevalence of feline hyperthyroidism, but also for geographical variation in the prevalence of the disease. Despite its frequency, the underlying cause(s) of this common disease is or are not known, and therefore prevention of the disease is not possible. Due to the multiple risk factors that have been described for feline hyperthyroidism, however, it is likely that more than one factor is involved in its pathogenesis. Continuous, lifelong exposure to environmental thyroid-disruptor chemicals or goitrogens in food or water, acting together or in an additive fashion, may lead to euthyroid goitre and ultimately to autonomous adenomatous hyperplasia, thyroid adenoma and hyperthyroidism. This review aims to summarise the available published evidence for the changes observed in the worldwide prevalence of the disease, as well as risk factors that may contribute to development of hyperthyroidism in susceptible cats.

Association of multinodular euthyroid goitre with some genetic markers

Distribution of blood groups ABO, Rh, Pu and MN was studied in 85 patients with multinodular euthyroid colloid goitre. An association has been revealed between the presence of this disease and MN blood group, as well as the absence of Pi antigen. These results permit us considering MN blood group and P| antigen absence as factors of risk for multinodular euthyroid colloid goitre.

Treatment of juvenile goitre with levothyroxine, iodide or a combination of both: the value of ultrasound grey-scale analysis

The effects of oral iodide, levothyroxine and of iodide and levothyroxine in combination were studied in three groups of 30 children, age 13–15 years, with euthyroid goitre. As endpoints of this study, we used thyroid volume reduction, thyroid hormones, thyrotropin and thyroid grey-scale histograms by computerized analysis. The three groups were well matched with respect to mean age, body weight and pretreatment thyroid volumes and thyroid hormones. Mean urinary iodide excretion before treatment was in the range of 30 μg/g creatinine, since the study was conducted in an iodine-deficient area. All three treatment regimens led to significant reductions in thyroid volume within one month. After six months on 100 μg of levothyroxine, thyroid volume had decreased from 14.1±4.2 ml to 8.3±2.6 2.6ml (mean±sd);on 150 μg of iodide, from 18.5±6.2 ml to 8.8±2.7 ml; and on 100 μg of iodide plus 50μg of levothyroxine, from 17.2±3.1 ml to 8.3±2.0 ml. When treatment was discontinued for three months, or the dosage reduced, thyroid volume increased again in the levothyroxine (to 11.3±2.5 ml) but not in the iodide group. Grey-scale values (by ultrasound, computer-aided estimation) after nine months were significantly different between the three treatment groups; no change was observed with levothyroxine, but after 150 μg of iodide as well as after combined treatment with levothyroxine and iodide there were marked decreases of grey-scale values; this is interpreted as reflecting a decrease in follicle size and colloid content of the thyroid which takes place after iodide supplementation. In conclusion, iodide treatment as well as combined treatment with levothyroxine and iodide lead to volume reduction of juvenile goitre which is quantitatively similar but qualitatively superior compared to the effects of levothyroxine alone.